Private Hospital Inpatient Referral Form

Inpatient Referral

Royal Rehab Private Hospital offers innovative evidence-based programs, on-site hydrotherapy and a dedicated multidisciplinary team of professionals committed to helping patients achieve their goals. Our skilled and professional team include rehabilitation specialists, physiotherapists, exercise physiologists, speech pathologists, occupational therapists, dietitians, clinical psychologist, and nurses. Royal Rehab Private Hospital is a leading facility of choice for those requiring overnight inpatient nursing and medical care. Individually tailored programs are developed for patients based on mutually agreed and meaningful goals.


Patient Details


Address


Contact


Details

Sex*

Interpreter Required?

Aboriginal/Torres Strait Islander?


Next of Kin


General Practitioner


Health Fund Details


Health Information

Does the client have difficulty communicating?*

Is the client orientated?*

What is the clients weight bearing status?


Rehabilitation Program

Type of Rehab Program*


Referral


Consent


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